Effects of exercise interventions on sleep quality in university students: a systematic review and meta-analysis.

UNLABELLED: Sleep disturbance affects up to 70% of university students globally, yet the comparative effectiveness of different exercise modalities remains poorly understood as existing reviews are limited to single exercise categories or English-only databases. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) identified by searching PubMed, Web of Science, and CNKI from inception to June 2026. Eligible studies examined structured exercise ≥2 weeks versus non-exercise controls in university students, with the Pittsburgh Sleep Quality Index (PSQI) as the primary outcome. Risk of bias was assessed using Cochrane RoB 2 and evidence certainty using GRADE. Twenty-two RCTs (N = 1,446) covering 14 exercise modalities were included. The overall pooled mean difference (MD) was -2.25 (95% CI: -2.83 to -1.68, p < 0.0001, I2 = 93.4%). Modalities with multiple replications showed consistent effects: combined exercise (k = 4, MD = -2.34, I2 = 0%), Tai Chi (k = 4, MD = -2.07), aerobic exercise (k = 2, MD = -2.10, I2 = 0%), and Qigong (k = 2, MD = -1.52, I2 = 0%). HIIT (MD = -4.44) and Baduanjin (MD = -4.37) demonstrated large single-study effects requiring replication. Overall GRADE certainty was low. Exercise interventions produce statistically robust improvements in sleep quality among university students. Combined exercise, Tai Chi, and aerobic exercise are the most consistently supported modalities and represent the strongest candidates for evidence-based implementation in campus wellness programs. SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD420261416062.